Corticosteroids

glucocorticoids mechanism of action

stimulates gluconeogenesis

anti-inflammatory effects (limits histamine release, prevents pro-inflammatory signal recognition by T-cells)

immunosuppressive effects

limited effects on sodium regulation

mineralcorticoids mechanism of action

salt and water homeostasis

part of the renin-angiotensin aldosterone system (RAAS)

cortisol route

endogenous

cortisol activity

1/1 (glucocorticoid/mineralocorticoid)

aldosterone available routes

endogenous

aldosterone activity

0.3/3000 (glucocorticoid/minerocorticoid)

hydrocortisone brand

Cortef

Solu-Cortef

hydrocortisone (Cortef, Solu-Cortef) available routes

PO, IV, IM

hydrocortisone (Cortef, Solu-Cortef) activity

1/1 (glucocorticoid:mineralocorticoid)

hydrocortisone (Cortef, Solu-Cortef) duration

8-12 hours

hydrocortisone (Cortef, Solu-Cortef) equivalent anti-inflammatory dose (mg)

20 mg

prednisone available routes

PO

prednisone activity

4/0.8 (glucocorticoid/mineralocortoid)

prednisone duration

short

prednisone equivalent anti-inflammatory dose (mg)

5 mg

prednisolone brand

Orapred

Millipred

prednisolone (Orapred, Millipred) routes

PO

prednisolone (Orapred, Millipred) activity

4/0.8 (glucocorticoid/mineralocorticoid)

prednisolone (Orapred, Millipred) duration

intermediate

methylprednisolone brands

Medrol

Solu-Medrol

methylprednisolone (Medrol, Solu-Medrol) routes

PO, IV, IM

methylprednisolone (Medrol, Solu-Medrol) activity

5/0.5 (glucocorticoid/mineralocorticoid)

methylprednisolone (Medrol, Solu-Medrol) duration

intermediate

methylprednisolone (Medrol, Solu-Medrol) equivalent anti-inflammatory dose

4 mg

triamcinolone brand

Kenalog

triamcinolone (Kenalog) routes

IM

triamcinolone (Kenalog) activity

5/0 (glucocorticoid/mineralocorticoid)

triamcinolone (Kenalog) duration

intermediate

triamcinolone (Kenalog) equivalent anti-inflammatory dose

4 mg

dexamethasone brands

Decadron, DexPak

dexamethasone (Decadron, DexPak) routes

PO, IV, IM

dexamethasone (Decadrom, DexPak) activity

25/0 (glucocorticoid/mineralocorticoid)

dexamethasone (Decadron, DexPak) duration

long

dexamethasone (Decadron, DexPak) equivalent anti-inflammatory dose

0.75 mg

fludrocortisone brand

(Florinef)

fludrocortisone (Florinef) routes

PO

fludrocortisone (Florinef) activity

minimal/125 (glucocorticoid/mineralocorticoid)

fludrocortisone (Florinef) duration

18-36 hours

glucocorticoid indications

autoimmune conditions (RA, Crohn’s, SLE, UC, GVHD)

transplant

oncology

asthma, COPD, gout, pericarditis, ARDS

steroids adverse effects

GI upset, hyperglycemia, weight gain/increased appetite, insomnia, agitation, leukocytosis, hypertension, slowed wound healing

long term steroids adverse effects

Osteoporosis, opportunistic infections, GI bleeding

corticosteroid replacement dosing

20 mg hydrocortisone (Cortef, Solu-Cortef) (15mg am and 5mg pm)

0.05-0.2 mg fludrocortisone (Florinef)

IV glucocorticoid replacement indication

adrenal crisis (most commonly d/t glucocorticoid withdrawal)

IV glucocorticoid replacement dosing

hydrocortisone (Cortef, Solu-Cortef) 100 mg IV x 1, then infusion of 10 mg/hours or intermittent doses of 100mg q8 hours

glucocorticoid stress dosing

minor stress: double the dose

severe stress or hypotension: 100 mg hydrocortisone (Cortef, Solu-Cortef) every 8 hours or 50 mg every 6 hours

steroid use in septic shock indications

septic shock not meeting resuscitative goals despite fluid resuscitation and vasopressor therapy

septic shock steroid dosing

hydrocortisone (Cortef, Solu-Cortef) 200mg IV/day

hydrocortisone 50 mg IV q6 hours

± fludrocortisone (Florinef) 50 mcg/day

when should steroids be tapered

doses that exceed 7.5mg daily for longer than 3 weeks

autoimmune conditions to prevent flair